During the holiday season we often think of those who need our help, but do we really understand their situation?

I want to share a story with you, so you can understand what life is like in rural Guatemala, living with diabetes.

Mynor is a young man, only 36 years old, yet he suffers from severe diabetes. Living in rural areas, he has not had access to good treatment and most of all he has not received good education about his illness. During 2014, he lost 50 pounds and could not walk well due to horrible nerve damage that was caused by his uncontrolled diabetes.

As is the case in Guatemala, many people search for care in many places before they are able to receive good diabetic care and sadly many are unable to find good care at all. Mynor came to us as a final resort, he has been searching for years and had tried many medications and natural remedies to cure his diabetes or make him feel better. Sadly, he purchased items he could afford, but was never able to afford the appropriate treatments to help him feel better.

When he came to our clinic, our team quickly saw that Mynor needed help! He was unable to work, unable to help his family with costs, he was barely able to walk and he was extremely malnourished. Our team explained that he needed treatment with insulin and intensive management of his nerve damage, to protect his kidneys, and control his blood pressure. He also needed to immediately gain weight to better his overall health and get his diabetes under control so his diabetes function could hopefully return to normal.

At only 36 years old, Mynor was being torn apart by diabetes, however with our donors support, we have been able to help Mynor down the road towards better health.

Thank you for your continued support of our diabetes programs! We look forward to counting on your support in 2015!

Since its inception, the Maya Health Alliance - Wuqu’ Kawoq diabetes program has been truly groundbreaking. Our cohort of approximately 150 diabetes patients is among the largest clinical diabetes programs described in the global health literature, and, as far as we know, Wuqu Kawoq’ may be the only organization in Guatemala providing free, truly comprehensive diabetes care. In addition, we always have maintained an unwavering commitment to Maya communities as roughly 80% of our patients with diabetes are monolingual in a Mayan language.

This year has brought many exciting developments to the Wuqu’ Kawoq diabetes program. First, although we have added approximately 25 new complex diabetics to our cohort since August 2013, we have maintained and even strengthened the high quality of our patient care. For example, in the six months since January 1, 2014, the percentage of our patients with “good” blood sugar control has improved from 41% to 53%, and the percentage of our patients with “very good” blood sugar control has risen from 21% to 32%. Much of this improvement stems from our successful efforts to persuade approximately 15 patients to intitiate insulin therapy. (This is no small feat; it took some patients more than three years to accept the necessity of insulin treatment to adequately control their diabetes!)

Second, we have recently hired a new diabetes nurse educator, Carol Teleguario, who makes regular home visits with complex patients as part of our new diabetes education study. Carol, a Kaqchikel speaker from Patzún, has been warmly embraced by our patients. We have not crunched the data yet, but based on what our patients are telling us, we think it is likely that diabetes education in home visits improves patients’ blood sugar control and program adherence.

Third, we have recently begun a pilot program to screen all patients for cardiac and kidney complications through the measurement of cholesterol and microalbuminuria, respectively. Such screening tests are standard-of-care in the U.S., but our program would be the first in the global health literature to offer such tests at no cost.

Finally, as we are always brainstorming ways to improve our program, we have other exciting diabetes program news in the “pipeline,” including news about drug procurement, eye care, and expansion of services into a new community. We look forward to sharing the news with you in the coming months!

At times, life is difficult for all of us. There are days when we don't want to get out of bed or days we are not sure how to make the best of a difficult situation. We understand that, which enables our patients to confide in us and put their trust in us to help them get better. In rural Guatemala, our diabetic patients face extremely difficult sitautions, especially when diabetes is poorly understood by family members and friends. Often, they receive poor advice about diet and mediciation and when they are trying to following a good diabetic diet, often family are misinformed and make it difficult for the diabetic patient to eat the foods they should.

We have worked together with our patients to understand their most difficult problems while batteling diabetes. Most often, it comes down to education and access to medications. We are thrilled that we can help our patients with both of these facets.

One of our patients, a 62 year old woman named Paula, told me "I always try to eat the right thing. I have tried cutting out sugar in my coffee and I rarely eat fried plantains any more and in the afternoons I have been trying to cut out my sweet bread. However, the most difficult factor is my husband, he always wants me to sit with him and have sweet bread and he loves plantains in the morning. I know these aren't good for me, but with him and my children always wanting the foods I can't eat, well it's hard to make more than one meal every day 3 times a day."

We understand Paula's concerns and we are excited to be growing our education program. We have continued pilot testing our program and we believe we are going to be making some fundamental changes to our program. These changes will focus on home educational visits wtih the diabetic and the entire family in order to educate and hopefully prevent diabetes among other family members.

The majority of our patients are able to control their diabetes through diet and some medication. However, we have several diabetics who need a lot more care, some needing insulin and even dialysis.

Our patient Amada, has been an incredible warrior batteling diabetes and has been on dialysis for many years. She lives far away from a hospital that can dialysis, which made it difficult for her to work or take care of her young daugher. We wanted to change that! We helped Amada to do dialysis at home! Amada compelted dialysis training sessions and has been doing DIY at home dialysis for over a year now. It took time to find her a place to live, incuding the construction of a small room that was a dedicated space to do dialysis. But now she is doing fantastic.

Amada makes the best of an extremely difficult situation in life. Here is Amada visiting with our nurse, Sandy, and showing us how she does dalysis at home: http://vimeo.com/71350398

From DIY dialysis to educating the family, not only the patient, we are helping diabetics learn and live!

Our research with rural diabetic patients in Guatemala has demonstrated that patients strongly prefer education classes and materials in the indigenous langauges. For example, many patients have explained that they fail to understand explinations in Spanish about diabetes control and diet modification. Most often, they return home after the consult with no resolution.

In order to provide the best care possible to our patients, we added an education course that incorporates indigenous knowledge and culture. The course is also taught in the indigenous langauge. We recently graduated the first class of adult, Kaqchikel Maya participants. The course was extremely successful! Participants explained that they not only learned how to control their diabetes with diet and medication in their own langauge, but for the first time ever they have found a strong social support in order to make the diet and liefstyle changes that are necessary to manage their diabetes.

One class participant explained that she struggled to follow the diet she was taught by us during consult, at home because no one else in her household understood her specific diet or its importance. But since we made family, friends, and the class particpants part of the learning process and key to supporting her and keeping her healthy, she now feels that now has the support at home and in the community to make better dietary decisions.

We are excited with the outcome from the first class and we can't wait to start more in January! Stayed tuned for more updates.

Dear Friends, this has been a really busy week for the diabetes program.

In previous months, I've hinted to you about the new educational initiative for diabetes patients that we are rolling out. Education, as you might expect, is a huge part of any diabetes program. Over the years, we've developed a number of educational materials for our patients, and our nurses and community health promoters also provided individualized, one-on-one education during regular home visits to patients and their families.

However, one big area that has been missing still is the creation of a sense of community among the diabetes patients themselves. For example, as we noted in a recent research publication (see the link below), many diabetics feel alone with their disease. They often also feel stressed by pressures within their own families that prevent them from making good health and dietary choices. To combat this, we are instituting peer support groups for our patients, which will meet regularly and will be facilitated by our health promotion staff. In the United States and other developed countries, this strategy has been very successful at improving patient satisfaction and also disease control, and we are looking forward to seeing what happens with our patients!

To make this program a success, we've brought on a new volunteer, who just arrived in Guatemala and will be working full time on this project over the coming year, helping our local staff get the program up to speed.

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